Anticholinergic therapy for acute asthma in children
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Published on: November 4, 2010
Laurel Teoh1, Christopher J Cates, Mark Hurwitz
1Department of Paediatrics and Child Health, The Canberra Hospital, Canberra, Australia. laurel.teoh@act.gov.au
Insights
Inhaled anticholinergics are less effective alone for treating acute pediatric asthma compared to beta(2)-agonists or combination therapy. These drugs are not recommended as a sole treatment for children with acute asthma exacerbations.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Inhaled anticholinergics are used for acute pediatric asthma, alone or with beta(2)-agonists.
- Effectiveness of single-agent inhaled anticholinergics in children over two years old with acute asthma requires evaluation.
Purpose of the Study:
- To assess the effectiveness of inhaled anticholinergic drugs as monotherapy versus a control in children over two years old with acute asthma.
Main Methods:
- Searched Cochrane Register of Controlled Trials (CENTRAL) and Cochrane Airways Group Register up to April 2011.
- Included randomized controlled trials (RCTs) of inhaled anticholinergics as single therapy in children over two years old with acute asthma.
- Two authors independently selected trials, extracted data, and assessed quality.
Main Results:
- Six studies of unclear quality with small sample sizes were included.
- Anticholinergics alone led to significantly higher treatment failure compared to beta(2)-agonists (OR 2.27) and combination therapy (OR 2.65).
- Conflicting data on clinical scores; lung function superior with combination therapy. No significant side effects noted.
Conclusions:
- Inhaled anticholinergics as single agents are less effective than beta(2)-agonists for acute pediatric asthma.
- Combination therapy with beta(2)-agonists is more effective than anticholinergics alone.
- Single-agent inhaled anticholinergics are not appropriate for acute asthma exacerbations in children over two years old.
Background:
Inhaled anticholinergics as single agent bronchodilators (or in combination with beta(2)-agonists) are one of the several medications available for the treatment of acute asthma in children.
Objectives:
To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma.
Search Methods:
The Cochrane Register of Controlled Trials (CENTRAL), and the Cochrane Airways Group Register of trials were searched by the Cochrane Airways Group. The latest search was performed in April 2011.
Selection Criteria:
We included only randomised controlled trials (RCTs) in which inhaled anticholinergics were given as single therapy and compared with placebo or any other drug or drug combinations for children over the age of two years with acute asthma.
Data Collection And Analysis:
Two authors independently selected trials, extracted data and assessed trial quality.
Main Results:
Six studies met the inclusion criteria but were limited by small sample sizes, various treatment regimes used and outcomes assessed. The studies were overall of unclear quality. Data could only be pooled for the outcomes of treatment failure and hospitalisation. Other data could not be combined due to divergent outcome measurements. Meta-analysis revealed that children who received anticholinergics alone were significantly more likely to have treatment failure compared to those who received beta(2)-agonists from four trials on 171 children (odds ratio (OR) 2.27; 95% CI 1.08 to 4.75). Also, treatment failure on anticholinergics alone was more likely than when anticholinergics were combined with beta(2)-agonists from four trials on 173 children (OR 2.65; 95% CI 1.2 to 5.88). Data on clinical scores/symptoms that were measured on different scales were conflicting. Individual trials reported that lung function was superior in the combination group when compared with anticholinergic agents used alone. The use of anticholinergics was not found to be associated with significant side effects.
Authors' Conclusions:
In children over the age of two years with acute asthma exacerbations, inhaled anticholinergics as single agent bronchodilators were less efficacious than beta(2)-agonists. Inhaled anticholinergics were also less efficacious than inhaled anticholinergics combined with beta(2)-agonists. Inhaled anticholinergic drugs alone are not appropriate for use as a single agent in children with acute asthma exacerbations.
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